Commission Change Consent Form

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Pursuant to and in compliance with New Jersey insurance regulation, specifically N.J. Stat. § 17:22-6.14, AmGUARD Insurance Company and/or NorGUARD Insurance Company, members of Berkshire Hathaway GUARD Insurance Companies with principal place of business at 39 Plaza Square, Wilkes-Barre, PA 18701, require the consent of appointed agents/brokers to modify commission rates in the state.  According to the statute, failure to achieve such mutual consent shall require that the agent’s contract be terminated as provided in the statute.

Upon reviewing the changes outlined in our announcement dated January 31, 2025, and further accessible via this link, please provide your agency’s consent by completing this electronic form.

By clicking “I Agree”, I acknowledge that I have the authority to execute this consent form on behalf of the agency cited and that I have reviewed the commission rate changes and hereby consent that the rate of commission being paid on each class of insurance on the date of enactment hereof shall be deemed to be pursuant to the existing contract between agent and company.

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Consent Confirmation*
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